Depression is a common and serious mental disorder that affects the way you feel, the way you think and how you act. It is characterized by depressed mood, feelings of guilt, low self-worth, decreased appetite, disturbed sleep, poor concentration, low energy, loss of interest, loss of pleasure, among others. It is important to note that different people exhibit different symptoms of depression (Bhowmik et al., 2012).
Globally, depression has been identified as a major cause of disability and premature death. It is widespread across all age groups, prevalent in both genders, affecting individuals from all walks of life (Bembnowska & Josko-Ochojska, 2015). This article seeks to add to the existing body of literature on depression by highlighting the different types of depression, causes of the illness, its symptoms, and available interventions.
According to research findings, there is no single cause of depression. However, it may occur as a result of three things, that is,
According to Bembnowska and Josko-Ochojska (2015), depression might be caused by a combination of various factors including:
According to research findings, depression runs in families and hence, some people inherit genes from their parents which make them likely candidates for depression. If a person comes from a family with a history of depression, then, their genetic makeup makes them likely candidates to suffer from depression during their lifetime.
On the contrary, an individual may still have a genetic makeup that makes them vulnerable to depression but they fail to suffer from the illness in their entire lifetime.
In addition, there are many cases where an individual may suffer from depression and yet they have no family history of depression.
These relate to changes in brain structure and or function. The functioning of the brain is a delicate process that employs use of chemicals known as neurotransmitters. These neurotransmitters aid in relaying messages between nerve cells in the brain.
Some neurotransmitters play a significant role in mood regulation. They include serotonin, dopamine, acetylcholine, nonrepinephrine, and gamma-aminobutyric acid. Therefore, when a person experiences a deficiency in any of these neurotransmitters, they are likely to suffer from depression.
These factors are concerned with how individuals perceive themselves and the world around them. In most cases, a person who is always pessimistic and negative is likely to suffer from depression in contrast to another person who is more optimistic and positive in matters life.
These are events that take place in an individual’s surrounding that have a lot of bearing on their state of mind. When these events become too stressful to an individual, depression is a likely outcome. Life stressors such as financial difficulties, a serious family loss, a stressful job, relationship/marital conflict, are among environmental factors that may trigger a depressive episode in an individual.
Research shows that physical changes that occur in the body of an individual are likely to be accompanied by mental changes. Medical conditions such as a heart attack, a stroke, cancer, hormonal disorders may trigger a depressive episode in an individual making them apathetic and unwilling to take good care of their body.
Depression manifests differently for different people. Following is a description of symptoms of depression as manifested by different age groups.
According to Bhowmik et al. (2012), the following symptoms of depression are associated with adults
Younger children may manifest the following symptoms of depression:
Adolescents and teens may manifest the following symptoms of depression:
Older adults may manifest the following symptoms of depression:
The first thing to do in the pursuit of treatment is to visit a mental health professional (psychiatrist/psychologist) or health care provider.
The specialist can examine you, conduct an interview, and perform laboratory tests, in an effort to rule out all the other conditions that may be causing similar symptoms to those of depression.
Once properly diagnosed, depression can be treated using medications, psychotherapy, or a combination of the two approaches.
According to Bhowmik et al. (2012), mental health practitioners recognize the following types of depression:
Major depressive disorder (MDD) is a debilitating illness characterized by depressed mood, impaired cognitive function, diminished interests, reduced appetite, and disturbed sleep. It is also known as ‘clinical depression’, ‘major depression’, or ‘unipolar depression. The disease occurs twice as much in women than in men. Research findings indicate that one out of every six adults is at risk of suffering from MDD during their lifetime (Otte et al., 2016).
Major depressive disorder is associated with alterations that occur in regional brain volumes, specifically the hippocampus. The disease may also be triggered by functional changes that happen in brain circuits, such as the affective-salience network and the cognitive control network. In addition, disruptions in the main neurobiological stress-responsive systems (such as the immune system and the hypothalamic-pituitary-adrenal axis) can trigger MDD (Etkin et al., 2015).
According to DSM-5, a person suffering from major depressive disorder exhibits at least five of the following symptoms:
According to Otte et al. (2016), treatment of major depressive disorder involves use of:
Psychotherapy approach utilizes the following interventions:
Pharmacological treatment of MDD utilizes glutamatergic antidepressants for example ketamine. Patients who fail to respond to pharmacological treatment(s) are usually subjected to an advanced form of medication called electroconvulsive therapy (Otte et al., 2016).
Dysthymia is a chronic mood disorder that persists for no less than two years in adults, and at least a period of one year in adolescents and children.
Dysthymia, also known as persistent depressive disorder, is caused by anomalous neurotransmitter signaling and hormonal abnormalities. Factors that perpetuate these abnormalities include social isolation, chronic stress, and childhood or adult trauma (Griffiths et al., 2000).
Moch (2011) identified the following symptoms of dysthymia:
Dysthymia is treated using both pharmacotherapy and psychotherapy approaches. However, a combination of the two methods has proven to be more effective than when either of them is used in isolation (De Lima & Hotopf, 2003).
Pharmacotherapy approach involves use of:
Among the three, SSRIs are most preferred because they are better tolerated compared to the rest (De Lima & Hotopf, 2003).
Hollon and Ponniah (2010) identified the following psychotherapy approaches used to manage dysthymia:
Bipolar disorder is a brain illness that results in an unusual shift in mood, level of activity, energy, and ability to undertake daily tasks. It is characterized by “periodic” or “cyclic” illness, where patients cycle “up” into a manic episode(s), and thereafter, cycle “down” into a depressive episode, from which they eventually recover. Bipolar disorder is also known as manic depressive illness (Yadav et al., 2013).
Yadav et al (2013) established that bipolar disorder is caused by three main factors, including:
Bipolar disorder is comprised of two episodes with the following symptoms:
Symptoms of the manic episode include:
Symptoms of the depressive episode include:
According to Bhowmik et al. (2012), bipolar disorders are characterized by cycles of mood (mood-switches) which include no less than one episode of mania (elevated mood) accompanied with episodes of depression. These disorders are both chronic and recurrent. The mood switches may by dramatic and rapid, or gradual. While in the depressed cycle, an individual exhibits one or all the symptoms of a depressive disorder.
Yadav et al (2013) identified four types of bipolar disorders.
Bipolar disorders can be treated using mood stabilizing medications. Lithium is an example of a mood stabilizing medication that can be used to treat mania. Anticonvulsant medications such as valproate and carbamazepine can be used to treat stubborn bipolar episodes (Yadav et al., 2013).
Psychotherapy as well as talk therapy have also proven effective in the treatment of bipolar disorder (Yadav et al., 2013). Examples of psychotherapy treatments for bipolar disorders include:
Atypical antipsychotic medications such as clozapine, olanzapine, risperidone, and ziprasidone have proven effective in treating bipolar disorder patients who fail to respond to lithium or anticonvulsant medication (Lieberman et al., 2005).
Electroconvulsive Therapy (ECT) may be adopted when pharmacotherapy and psychotherapy interventions fail to yield expected results (Yadav et al., 2013).
Psychotic depression is a subtype of major depressive disorder (MDD) characterized by delusions (having irrational thoughts and/or fears), hallucinations (hearing or seeing things that aren’t really there), disorganized thinking, incoherent speech or some other break with reality (https://www.mind.org.uk/media-a/4293/psychosis).
A psychotic individual is one who has lost touch with reality. Psychotic persons hear “voices” and have strange and illogical ideas. For instance, such a person may think that others can ‘hear’ their thoughts or are trying to hurt, control, or even kill them. In other situations, a psychotic person may think they are some famous person, for example, the President of the republic, and such stuff (https://www.mind.org.uk/media-a/4293/psychosis).
A psychotic person easily gets angry for no valid reason. Such persons keep to themselves, sleep a lot during the day and remain awake at night. They may totally neglect appearance by not taking a bath or changing clothes. They are also hard to talk or say nonsensical things when they speak (http://www.mindclinics.org/library/assets/Psychotic%20Depression-033510.pdf).
Research is still in progress regarding the actual cause of psychotic depression. However, the illness may be triggered by either of the following factors:
An individual suffering from psychotic depression will have the following symptoms:
Psychotic depression may be treated using both psychotherapy and pharmacotherapy interventions. These are explained in the following subsection.
Seasonal affective disorder is a type of major depression that keeps recurring during a specific period of time each year. It thus follows a seasonal pattern which mostly occurs during winter season of the year (hence the term “winter blues”). For the depression to be categorized as SAD, it must occur for a period of no less than two years (American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders (DSM-5), 2013).
A person with seasonal affective disorder has difficulty regulating a neurotransmitter known as serotonin. Serotonin’s main function is mood balancing. Research findings indicate that during winter, persons with SAD happen to have higher levels of SERT in their system. High levels of SERT usually decrease the action of serotonin, which result in a depressed mood (McMahon et al., 2014).
Individuals with SAD also experience production of excess melatonin. Melatonin is a hormone that causes a person to feel sleepy when darkness falls. Given that winter days are darker, persons with SAD will have more melatonin produced in their systems. As a result they tend to feel sleepy and lethargic most of the time (http://www.nhs.uk/Conditions/Seasonal-affective-disorder/Pages/Symptoms.aspx.).
Another cause of SAD in individuals is lack of exposure to sunlight which occurs during winter. Lack of exposure to enough sunlight results in less vitamin D production in the body of the individual. Vitamin D is believed to play a vital role in serotonin activity. Thus, deficiency as well as insufficient vitamin D leads to a depressive mood in SAD individuals (Kerr et al., 2015; Kjaergaard et al., 2012).
According to Zauderer and Ganzer (2015) symptoms of seasonal affective disorder during winter season revolve around sad mood and low energy. They include the following:
Seasonal affective disorder is treated using a combination of several methods including antidepressant medication, vitamin D, light therapy, and counseling (Melrose, 2015).
Given that SAD is related to a dysfunction in brain serotonin activity, second generation antidepressants (SGAs) for instance, Selective Serotonin Reuptake Inhibitors (SSRIs) have emerged as favourable antidepressant medication treatments. An example of SGA SSRI used to treat SAD is fluoxetine, also known as Prozac (Cheung et al., 2012).
Another SGA SSRI that can be used to treat SAD is Bupropion also known as Wellbutrin (Modell et al., 2005).
According to Gloth III et al. (1999), people with SAD are advised to take vitamin D doses as this helps prevent symptoms of depression from manifesting during winter days.
Light therapy, also known as phototherapy or Bright Light Therapy (BLT) involves use of bright artificial light to replace the diminished winter sunshine. Light emitting boxes to be used for this purpose can be bought from specialized stores. These boxes have the capacity to emit full spectrum light whose composition is similar to sunlight (Eagles, 2009).
A person with SAD can be relieved of their depression symptoms by simply sitting in front of the light box early in the morning, and this should be carried on from fall until spring time (Weil, 2015).
Counseling approaches that can be used to aid and support people with SAD include Cognitive Behavioural Therapy (CBT), which can be provided in a group format. Also to be used are programs that assist people to improve their diet by reducing intake of starches and sugars; increasing frequency of exercise, effectively manage stress, spending their time outdoors, and avoid social withdrawal (http://www.nhs.uk/Conditions/Seasonal-affective-disorder/Pages/Symptoms.aspx).
Post-partum depression is a mood disorder that mostly affects first-time mothers. Research shows that the disorder affects about 10 to 15% of new mothers (Gaynes et al., 2005).
For new mothers, the period following childbirth is usually accompanied by intense physiologic and psychological changes. As such, many vulnerable women end up developing depressive episodes. According to Kumar and Robson (1984), the following are some of the factors that place new mothers at risk of developing post-partum depression:
Kammerer et al. (2009) identified several symptoms of past-partum depression including:
Post-partum depression can be treated using a variety of methods depending on the root cause of the problem. Both pharmacological and non-pharmacological methods can be used. However, non-pharmacological method or psychotherapy is preferred because there is no infant exposure to medication during breastfeeding (Dennis & Chung-Lee, 2006).
Two commonly used psychotherapy methods for treating post-partum depression are:
Pharmacotherapy approach involves use of recommended drugs to mitigate the effect of post-partum depression. In this regard, selective serotonin reuptake inhibitors (SSRIs) such as fluoxetine, nortriptyline, paroxetine, and sertraline are frequently used (Payne, 2007).
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